Provider Demographics
NPI:1215287420
Name:MCCORD, CHARLES KEITH (PA)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:KEITH
Last Name:MCCORD
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Gender:M
Credentials:PA
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Mailing Address - Street 1:1005 DR DB TODD JR BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-3501
Mailing Address - Country:US
Mailing Address - Phone:615-327-5944
Mailing Address - Fax:615-327-5597
Practice Address - Street 1:16850 BEAR VALLEY RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5794
Practice Address - Country:US
Practice Address - Phone:760-241-8000
Practice Address - Fax:760-962-8021
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2019-01-04
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Provider Licenses
StateLicense IDTaxonomies
CAPA22512363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant